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Haha, 745 million a year. That has to be the biggest tosh I´ve ever heard. As long as the wait is more than 20 minutes, it will just reduce waits slightly (and when is it not?). Or do the doctors sit and stare at the wall in 20 minutes if there´s a no-show?

There's only an administration cost if you do the time-and-motion calculation by dividing someone's time by appointments.

But that's not really accurate. The real question with costs is: how many people can we get rid of. And as most receptionists aren't heavily utilised and are localised to a ward/GP surgery (rather than in a call centre), the answer is about nothing.

The government is very keen to calculate the public's time saved when, e.g. planning a new road, but when it comes to the NHS, saving the public time is suddenly of no consequence. Where in this calculation is the benefit in time saved to other patients who get seen quicker thanks to the no-shows?

It tends to be the first appointments who don't turn up, i.e. 9am, 2pm, so the doctors actually do sit and stare at their computer screens. It takes about 20 minutes to log on to an NHS hospital computer anyway.

If you think anyone gets seen quicker because of no-shows, you are sadly mistaken. Clinic bookings are now run like airline bookings, though only on intuition rather than actual evidence. For example, if you figure that people are unable to wake up in January, you just book 3 people for 9am and usually only one will turn up. When all 3 turn up, that's when you get seen at 10.

There's no point of turning up early as you will be seen in order of your original appointment, but if you're late you will go to the back of the pile, even if you would still have been waiting had you arrived on time. In the US, some doctors will actually pay you if they are late.

The above is true for hospitals. In GP-land appointments are meant to be 10 minutes long. The average consultation length plus note typing is 12 minutes, which is therefore accommodating to no-shows by design.

a) doctors adopt the same strategy as airlines, and allow slightly too many people to book on the assumption that there will be a certain % of no-shows so it all cancels out nicely, or

b) doctors give appointments on the assumption that every single patient will turn up on the dot, GPs never overrun their ten minute slots and would rather sit there staring into space for ten minutes rather than see the next patient (who might have turned up early).